putting the consumer first: consumer direction in long-term care
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Putting the Consumer First: Consumer Direction in Long-Term Care. March 31, 2009 Chuck Milligan Innovation in Health Policy Series DC Department of Health Care Finance. Overview. Portrait of Long-Term Care Consumer Direction Two Examples from Mi Via (from DVD) - PowerPoint PPT PresentationTRANSCRIPT
The Hilltop Institute was formerly the Center for Health Program Development and Management.
Putting the Consumer First:Consumer Direction in Long-Term Care
March 31, 2009
Chuck Milligan
Innovation in Health Policy Series
DC Department of Health Care Finance
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Overview
Portrait of Long-Term Care
Consumer Direction
Two Examples from Mi Via (from DVD)
Needed Functions and Competencies
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Portrait of Long-Term Care
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Medicaid and Medicare are the major third-party payers for long-term care, and out-of-pocket is high.
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Expenditures in Medicaid long-term care continue to grow, especially for community-based services.
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Medicaid is the largest payer for nursing home care.
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36 percent of Medicaid expenditures, or about $109 billion, goes toward long-term care . . .
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DC utilizes institutional services at a higher-than-average rate.
United States
58.3%
41.7%
Source: Thomson Reuters
DC ranks 40th
out of 51
DC
67.4%
32.6%
% Community-Based
% Institution-Based
Distribution of Medicaid LTC Dollars, FY 2007
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Consumer Direction
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Aspects of Consumer Direction More flexibility in benefit design
Still subject to some level of approval/oversight Agency must balance: serving beneficiaries and serving
taxpayers
More control of benefit choices and use Have sufficient independence from provider? Overuse? Underuse?
More control of prices Have sufficient “market power”? Have sufficient independence from provider?
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Two Examples from Mi Via (from DVD)
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Needed Functions and Competencies
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Functions and Competencies Financial management
Review purchases Connect to plans of care Receive and process invoices, connected to plans of care Protect against fraud & abuse by provider and/or beneficiary
Counseling Assist beneficiaries in developing budgets and making decisions Assist beneficiaries in hiring, firing, training, & scheduling workers
Market role Monitor prices and supplier behavior
Determine credentialing standards for paid providers
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Contact Information
Charles Milligan
Executive Director
The Hilltop Institute
University of Maryland, Baltimore County (UMBC)
410.455.6274
www.hilltopinstitute.org